IEPA 2012

Background: Dysfunction of the prefrontal cortex (PFC) is consistently reported in patients with schizophrenia. Three types of dysfunction have been described: (1) hypofrontality, (2) hyperfrontality and (3) failure to deactivate the medial PFC (mPFC). The latter finding may be associated with dysfunction of the default mode network (DMN), which is relatively deactivated during goal-oriented activity in healthy subjects. However, it is unclear if DMN-dysfunction is present before the onset of psychosis, and, if dysfunction is mediated genetically or related to early symptom manifestation.

Background: Because long-acting injectable (LAI) antipsychotics are largely reserved for persistently ill patients, little is known about the use of LAIs for “first-episode” outpatients. Methods: A prospective randomized controlled trial (RCT) between 12/2004 and 3/2007 of “first-episode” DSM-IV schizophreniform, schizophrenia, or schizoaffective disorder treated in an urban, public mental health service. Subjects were randomized at a 2:1 ratio to recommendation of LAI risperidone microspheres (RLAI) (n = 26) or continuation oral antipsychotic (ORAL) (n = 11), for up to 104 weeks.

There are suggestions that some first episode psychosis (FEP) patients can have favorable outcome without antipsychotic medication. However, there is very limited data regarding patients’ characteristics on which the decision to propose medication free treatment could be based. FEPOS is a file-based study of an epidemiological sample of 704 FEP patients treated at EPPIC, Melbourne, between 1998 and 2000. Among the 661 patients where data was available, 108 consistently refused medication during the entire duration of their treatment at EPPIC.

Increasing evidence suggests that early intervention can be effective and cost-effective in treating early psychosis. However, few intervention programs exist in the U.S. outside of academic medical centers. We present initial outcomes for PREP, a community-academic partnership program in San Francisco, CA serving adolescents and young adults with recent-onset psychosis (within 5 years of first psychotic episode) or at clinical-high-risk for psychosis.

Increasing evidence suggests that childhood trauma confers risk for later psychosis, with dysregulated stress responsivity via the hypothalamic-pituitary-adrenal (HPA) axis as a hypothesized mechanism. However, few studies have examined this model prospectively, prior to psychosis onset. We assessed childhood trauma and salivary cortisol levels in adolescents and young adults at clinical high risk (CHR) for psychosis and age-matched healthy controls (HCs). Cortisol samples were taken to assess diurnal rhythms, response to a laboratory stressor task, and response to dexamethasone.

In a series of publications, we described the development of the Prodromal Questionnaire (PQ), a self-report screen for clinical high risk (CHR) for psychosis, and a brief version of the measure, the PQ-B. To date, we have reported primarily on the concurrent validity of the measure by comparing it to diagnoses on the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms (SIPS/SOPS).

Introduction: In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of several recent studies. Our aim was to study global psychosocial state and outcome in CHR patients, as well as factors associating with baseline state and short-term outcome. Methods: In the EPOS (European Prediction of Psychosis Study) project, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter Prognostic Scale (SCPS) at baseline, and 149 (61.1 %) of them were assessed for the second time at 18-month follow up.

Aims: There is an association between severe mental illness, particularly psychosis, and violent or offending behaviour. Most violence among those with psychosis occurs during the first episode of illness, prior to the initiation of treatment. Reducing the risks of violence in this population is clearly desirable, however guidance is limited. This presentation describes and evaluates a pilot forensic outreach program established to reduce risks of violence among patients identified as being at high risk of, or already demonstrating, violence and offending.

The relationship between weight gain and the treatment of first episode psychosis (FEP) with psychotropic medication has been well established, with obesity and metabolic syndrome common sequelae. Such metabolic abnormalities create further disease burden on a population already dealing with mental illness, whose life expectancy is approximately 20 years less than the general population, primarily due to cardiovascular complications.

Carers of young people who are experiencing their first episode of psychosis face considerable burden emotionally, psychologically, physically, and economically. Understanding ways in which carers cope with such burden is not only important for providing support to carers but may maximise patient outcomes. Thus, the aim of this study was to examine strategies carers use to cope with the burden of caring for a young person with first episode psychosis (FEP).